Deconstructed Protocols

I have been on a bunch of long, cross-country type flights lately. And part of the deal with a long flight is the time honored tradition of casually glancing at the laptop or tablet of the person sitting next to you to catch a glimpse of their Facebook feed, the movie they might be watching, or my personal favorite - the contents of the PowerPoint deck they are likely about to present the next day.

On my flight from JFK - SFO yesterday I succumbed to my curiosity to steal a glimpse (or three), at my neighbor's laptop. She was preparing and refining a PowerPoint presentation on some kind of really, really complex subject related to health care and disease control in hospitals (I think). While I was not able to make sense of the slides that I was able to see, one slide in her deck just about jumped out at me. It was the slide that seemed to mark the transition from 'These are all the crap things that are going on right now' to the section that would hold the ideas on 'Here is how we fix this mess and (hopefully) fewer people die.'

The slide was titled 'Deconstructed Protocols.'

And when I saw the slide title, I was really blown away. The gist of her presentation, I think, was how hospitals needed to really break down and dissect the specific steps, or protocols, associated with a certain procedure in order to try and figure out why an unacceptable level of post-procedure complications, like infections, have been occurring. And the only way to try and fix the problems is to tear down every element, every step, every piece of communication, every patient interaction, every handoff of responsibility, every piece of equipment used, every medication prescribed, and probably a dozen other things, and assess them both individually and as they exist and contribute to the overall process.

All of which, for a complex medical process, seems absolutely exhausting and probably has lots or people lined up against it.  

Deconstructing this process will take ages, will make people in high positions uncomfortable, and will likely require increased investment in the short term thay may take some time to pay off. All things that are hard, are hard to sell internally, and often have people lined up against anyone trying to drive the changes that need to be made.

What is the point of all this? 

A guess just a good reminder that even in situations like in a health care setting where making needed process, technology, or workflow changes can result in PEOPLE NOT DYING, often the agents of change run up against all the same barriers that you run into in your corporate role.

It will cost too much. This will anger the VP of something-something if you cut his team out of the process. You can really KNOW for sure if your changes will have the desired effect. And on and on and on.

But I hope you stick with it regardless. 

Maybe you are not in the business of saving lives but I bet the change you are (or want to) advocate for will make people's lives better - employees, candidates, managers - doesn't matter. Even when the benefits are obvious and important, effecting change is still hard.

And when the benefits are less clear, like as in most of what we do in HR/Talent, it is even harder. But keep the faith. And deconstruct the protocols.

Have a great week!

Comments

[Akabruno]

Breaking down protocols was a central point of Atul Gawande's "the Checklist."

[Steve]

Very good reference, Professor.

[Ceil Tilney]

Great post - having spent a few years inside healthcare delivery systems (and more consulting to different parts of the healthcare ecosystem), I saw first hand the creative and destructive power of medicine-as-art versus medicine-as-process-driven-science. It's both, and the challenge talent and change leaders might best address is how to help the people in healthcare delivery know when each frame is most appropriate.

For example, sophisticated diagnoses of truly complex and rare conditions combine art and science. Making sure your hands are sterile before you perform surgery does not. Effective healthcare delivery cultures allow approporiate latitude for the truly-art decisions, without letting that latitude slop over into granting individuals the right to decide for themselves if they want to conform to proven procedures.

The most recent research I'm familiar with says only 1/3 of surgeons routinely sterilize before operating. We have a ways to go.